MORE TAXES AND FEES: Jessica Holmes, a member of the Green Mountain Care Board, breaks down a myriad of statistics on the trends of private and public health care providers for the Senate Healthcare Committee on Thursday morning last week.

MONTPELIER — At the Senate Health and Welfare Committee, senators took testimony regarding whether to impose additional taxes and regulations for independent health care providers that aim to provide more affordable care than their hospital counterparts.

S.278 sponsored by state Sen. Claire Ayer, D-Addison, proposes to establish a regulatory framework for ambulatory surgical centers. The Vermont Eye Surgery and Laser Center in South Burlington, and the yet-to-open Green Mountain Surgery Center in Colchester, are the only two centers the measure would affect.

On Thursday, representatives from each testified on how overregulation will overburden their ability to function. Testimony that day included written comments from William Prentice, CEO of the Ambulatory Surgery Center Association, which represents the interests of the two providers.

“Many of the provisions outlined in S.278 are more limiting than federal regulations. We believe … Vermont would become the most restrictive state for ASCs in the entire country,” he stated.

“In order to participate in the Medicare program, ASCs are required to meet certain conditions set by the federal government to ensure that the facility is operated in a manner that assures the safety of patients and the quality of services.”

Jessica Holmes, a member of the Green Mountain Care Board, told the committee that there is a national trend away from independent practices towards to the public sector. She cited a 40 percent market shift from private sector to public since the 1980s. Also, since 2012, the number of physicians identifying as independents has fallen from half to one-third.

“Both national and here in Vermont, more providers are choosing employment in hospital systems rather than practice independently,” Holmes said.

The result is more concentrated healthcare systems centered around big hospitals, with full or partial control of other smaller healthcare centers within the region. Holmes said such an industry shift has its pros and cons.

“There’s potential for higher prices and a more concentrated market,” she said. “But there’s also the potential for greater care coordination and cost savings through economies of scale.”

According to Holmes, surveys of independent and public physicians found the top threats to their practices are over-regulation, healthcare payment reforms and low Medicaid reimbursements.

Sen. Ann Cummings, D-Washington, said the two private centers emerged in Vermont because they can offer care at lower costs than hospitals. She appeared to agree that too much regulation might raise costs and undercut the purpose of the new centers.

“If we do to them what we have done to everybody else, which is to make it so they have to hire new people to comply with our requirements, we are impacting that benefit,” she said.

On the regulation side, David Herlihy, executive director of the Vermont Board of Medical Practice, said affordability is important, but so is safety. His organization is responsible for issuing licenses and certifications to physician assistants, allopathic physicians, podiatrists, anesthesiologist assistants and radiologist assistants.

“I think they look at safety and they ask, ‘Is this applicant, is it going to be good from an economic standpoint and are they going to provide safe care?'”

Herlihy added while he generally supports S.278, it might go a bit too far. “I think there are a lot of things in the bill that go way beyond what is required of the hospitals, from a regulation point of view.”

Devon Green, vice president of government relations for Vermont Association of Hospitals and Health Systems, spoke to why her organization is in favor of the measure. She said there are two primary philosophies that states can take for health care, which are to treat it as a commodity or to treat it as a public good.

“Those states that treat it as a commodity, they generally have a hands-off approach to regulation and that can sometimes lead to competition, but in the world of health care that sometimes leads to an increase in overall costs,” she said.

Green said Vermont needs to focus on the public good, and said the creation of the Green Mountain Care Board was based on this notion as well.

“[We need] to put emphasis on providing Vermonters with quality care while reducing the total cost of care,” she said.

The socialist schemes always talk about COST SAVINGS. And yes, a monopoly can avoid some costs which is to their benefit. That’s why they bribe their way into a monopoly position in the first place. But, please note, they are careful not to make false promises about PRICE REDUCTION because that is not part of the plan. (Everyone should, but seldom does, take care to distinguish between cost and price.)

The art of the con by the Green Mountain Care Board that is constantly trying to protect their monopolies that lobby so well.

Good ideas don’t cost money, bribes and market protection to build monopolies do. We want to tax the lobbyists, it’s bribe money anyway. Green Mountain Party, see us on face book. Help us make Vermont Affordable.

“Green said Vermont needs to focus on the public good, and said the creation of the Green Mountain Care Board was based on this notion as well.“[We need] to put emphasis on providing Vermonters with quality care while reducing the total cost of care,” she said.” GMCB WAS CREATED TO USHER IN SINGLE PAYER AND SUBSEQUENTLY ALL-PAYER – GOVERNMENT RUN HEALTHCARE. GOVERNMENT SEEKS TO REDUCE HEATH CARE COSTS BY LIMITING EXPENDITURES UNDER A GLOBAL BUDGET – RATIONING. IT DOES NOT DECREASE COSTS TO CONSUMERS/PATIENTS. GMCB SEEKS TO CONTROL ALL FINANCES OF MEDICAL PROVIDERS, INDIE OR OTHERWISE. TIME AND TIME AGAIN, EXAMPLES SHOW THE RESULTS ARE NOT BETTER CARE FOR PATIENTS. THIS MODEL PUTS THE STATE, OR THEIR PROXY, BETWEEN THE PATIENT AND THEIR DOCTOR.

“Both national and here in Vermont, more providers are choosing employment in hospital systems rather than practice independently,” Holmes said.
THEY ARE FORCED TO CHOOSE SO BECAUSE THEY ARE SQUEEZED OUT OF PRIVATE PRACTICE BY REGULATIONS
“There’s potential for higher prices and a more concentrated market,” she said. “But there’s also the potential for greater care coordination and cost savings through economies of scale.” MONOPOLIES / BIG BUSINESS CAN ABSORB COSTS DUE TO SHEAR SIZE WHILE SMALL, INDEPENDENT BUSINESSES CANNOT.

“Sen. Ann Cummings, D-Washington, said the two private centers emerged in Vermont because they can offer care at lower costs than hospitals. She appeared to agree that too much regulation might raise costs and undercut the purpose of the new centers. “If we do to them what we have done to everybody else, which is to make it so they have to hire new people to comply with our requirements, we are impacting that benefit,” she said.”

Somewhere along the way we have lost the common sense knowledge that monopolies result in higher costs and poorer services for consumers because of the elimination of competition. This is what has happened in Vermont, and our heath care monopoly, UVM Medical Center and Green Mountain Care Board, are feeling threatened by the prospect of competition from “indie” medical practices. Rather than “level the playing field” by reducing onerous (and often unnecessary) regulations for all, they seek to bring down independent practices by saddling them regulations.